A 24-year-old male competitive bodybuilder is preoccupied with the belief that he appears small, thin, and inadequately muscular, although friends describe him as exceptionally well built. He avoids beaches and locker rooms, trains obsessively, follows extreme diets, and uses anabolic steroids. What is the most likely diagnosis?

• A Anorexia nervosa, restricting type
• B Delusional disorder, somatic type
• C Muscle dysmorphia, a specifier of body dysmorphic disorder ✓
• D Social anxiety disorder

Explanation

Muscle dysmorphia is a specified form of body dysmorphic disorder in which the preoccupation is with being too small or insufficiently muscular. It occurs almost exclusively in men, is associated with compulsive weightlifting, dietary rigidity, substance misuse such as anabolic steroids, and avoidance of exposure situations. Anorexia nervosa requires low body weight and fear of weight gain, both absent here. Social anxiety disorder lacks the fixed appearance preoccupation and compensatory behaviours described.

Reference: Diagnostic and Statistical Manual of Mental Disorders, DSM-5 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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